Infant Sleep Regressions

In this blog by Dr. Grabill we’ll explore the two most common ages for sleep regression during the first year of your baby’s life. Understanding the developmental stage of your infant informs not only why the sleep regression may be happening, but also the reasons for the different management approaches. For general information about sleep needs and approaches to establishing safe and healthy sleep routines for newborns and infants, you can read more in here.

4-Month Sleep Regression

The first of the common sleep regressions is around 4 months old. This is an age when your infant is becoming much more social and active. Your baby may be a lot more distracted by you and/or their environment when feeding and preparing for sleep. 4-month-olds are trying or starting to roll over, begin reaching out and grabbing with purpose, and bringing the objects they grab to their mouths. Because they have objects or their hands in their mouths, they drool a lot more. While these may look like teething signs, teething is still 2+ months away for most babies, and the drooling is result of stimulated salivary glands from hands/objects being in their mouths. Therefore, we cannot typically blame the 4-month sleep regression on teething like we can at 9 months old (see below).

Lastly babies are commonly transitioning to a more consolidated sleep schedule around this stage. Sleep consolidation is tied closely to feeding consolidation, so babies who are eating progressively larger volumes at each feeding will develop the ability to go progressively longer stretches between feedings. Sometimes the more distracted feedings will lead to lower volumes and therefore shorter stretches between feedings.

Tips for navigating the 4-month sleep regression:

(1)      Ensure your baby is getting enough milk. The growth curves at the 4-month-old check-up can provide reassurance that the calories consumed have been adequate to meet growth needs. If they are meeting their needs, you can feel reassured they are not needing to feed in the middle of the night. The 50th percentile 4-month-old is typically drinking 4-6 oz per feeding, and 28-32 oz per 24-hour period. Larger percentile babies may do slightly more, smaller percentile babies may due slightly less.

(2)      Decrease stimulation. For feedings you may need to go into a private, darker room. For the bedtime routine, dim or turn off lights (and in the longer summer days, you may want to close shades earlier to simulate it getting dark outside). Consider a sound machine with white noise to help calm your baby or to drown out the noise of older siblings elsewhere in the house.

(3)      Consider moving their bassinet or crib farther away from your bed within your bedroom if your baby’s sleep space remains in your bedroom.

(4)      If your baby has not yet developed the ability to roll over, you may continue to swaddle.

(5)      Give your baby a chance to self-soothe before rushing to their aid. You have spent several months teaching and reassuring your baby they are protected and cared for. A 4-month-old is not going to feel neglected if you do not rush to help them at the first whimper, cry or other vocalization or movement. There is no magical amount of time you should wait. For some families it’s 5 minutes, for others it’s 20-30 minutes, others still it could be a full cry-it-out. Do an amount of time that seems intuitive and reasonable.

(6)      If you feel external calming is needed, provide the least stimulation necessary to settle your baby. A reassuring shhhh or whisper, or soft touch while they lay is best. The farther from their crib or bassinet they move and the more time they spend with you, the more stimulated they may get. More stimulated babies will take longer to fall back asleep and may start to develop a bad habit of waking up more often to socialize.

9-Month Sleep Regression

The 9-month sleep regression is largely related to new teeth and new social milestones. The first tooth eruptions are commonly happening between 6 and 10 months old. The discomfort associated with teething can be ignored by the active, curious, and sometimes mobile 9-month-old. But when they are laying in their crib, they have little else about which to think besides their gums hurting. If you know your child is actively cutting new teeth, it is ok to preemptively give some acetaminophen or ibuprofen before bedtime each night for several days or even weeks in a row. Refer to our acetaminophen and ibuprofen dosing pages for the proper amount based on your infant’s weight. (NOTE: ibuprofen is NOT safe before 6 months old)

Developmentally, 9-month-olds are starting to develop separation anxiety from their parents and have the newly discovered concept of object permanence. For the 4-month-olds described above, if an object (or parent) is out of sight, it is also out of mind. 9-month-olds, on the other hand, will miss you and possibly call out for you, knowing that you are nearby even if they cannot hear, see, smell or otherwise sense you. For these reasons 9-month-olds are often more persistent in their crying out than 4-month-olds in sleep regression.

Tips for navigating the 9-month sleep regression:

1)         Try to avoid feeding them in the middle of the night. 9-month-olds should have well-established eating routines and are unlikely, therefore, to need calories in the middle of the night. In rare cases, however, a 9-month-old may start to quickly burn through calories due to crawling, pulling to stand and cruising. If you have tried everything else and end up trying to nurse or bottle feed to calm them in the middle of the night, observe how voraciously they eat. An infant feeding hungrily is one for whom you should increase breastmilk/formula and/or food intake during the day to meet their new calorie requirements. If they are pokey about the offered bottle/breast, stop offering it – it is a sign that milk (i.e. calories) is not what they are seeking.

2)         Try to avoid bringing your baby back into your room. Whereas 4-month-olds are commonly still in their parents’ bedroom, many 9-month-olds are in their own room. Bringing a child who has transitioned to their own bedroom back into their parents’ bedroom could establish a new and bad habit. Additionally, we strongly discourage having infants of any age in the bed with their parents and/or siblings due to the risk of Sudden Infant Death Syndrome (SIDS, sometimes also known as Sudden Unexpected Infant Death or SUID).

3)         Be selective on what criteria you use for entering their room to provide external calming. Because of separation anxiety, going into their room to calm them, only to leave again could make it harder for them to fall back asleep.

4)         As recommended above, if you feel it is right to calm your baby, try to do so with the least stimulation and intervention possible.

There is no single right way to navigate these sleep regressions, nor to “sleep train” your infant. The approach you select needs to seem intuitive to you as a parent (not the grandparents, not your best friends who have sleep trained their infants successfully, nor that social media personality trying to convince you their way is the best and only way). Hopefully, understanding a little more about the developmental stage of your infant during these regressions will help you find what works best for both you and your baby. If you are still struggling despite all this, it may be time to troubleshoot with one of our doctors or nurse practitioners.